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OBJECTIVE: This study aims to develop and evaluate a simple tool for daily practice that might allow a rough estimate of individual braking performance (brake response time, BRT) of patients with osteoarthritis or those with arthroplasty of the knee or hip. METHODS: In this cross-sectional study, we examined 162 patients (72 men, 90 women; mean age = 64±12.8 years) who suffered from osteoarthritis of the knee (n=45) or hip (n=64) or who underwent a total hip (n=37) or knee (n=16) arthroplasty. BRT of each patient was measured in a brake simulator. The results were compared to demographic data, various clinical tests, and pain surveys. From these data, a multiple linear regression model was developed. RESULTS: From the observed correlations, the regression model consisted of age (correlation with BRT τ=0.176, p=0.001), sex (τ=0.361, p

Background Numerous classification systems have been proposed to interpret lumbar MRI scans. The clinical impact of the measured parameters remains unclear. To evaluate the clinical significance of imaging results in patients with multisegmental degenerative pathologies, treating specialists can perform image-guided local injections to target defined areas such as the epidural space. Objective The aim of this retrospective study was to evaluate the correlation between lumbar spinal stenosis measurements obtained by MRI and improvement obtained through local epidural injection. Methods In this retrospective study various measurement and classification systems for lumbar spinal stenosis were applied to MRI scans of 100 patients with this pathological condition. The reported effect of epidural bupivacaine/triamcinolone injections at the site was recorded in these patients and a comparative analysis performed. Results MRI features assessed in this study did not show any relevant correlation with reported pain relief after epidural injection in patients with chronic lumbar stenosis, with the exception of posterior disc height with a weak Kendall's tau of -0.187 (p= 0.009). Conclusions Although MRI is crucial for evaluating lumbar spinal stenosis, it cannot replace but is rather complementary to a good patient history and clinical examination or the results of local diagnostic injections.

Archives of orthopaedic and trauma surgery 142(11), 3157-3164 (2022). doi:10.1007/s00402-021-03932-x, Published by Springer, Berlin ; Heidelberg

PURPOSE To assess whether reaction time (RT) and movement time (MT), as the two components of the total brake response time (TBRT) and brake force (BF) are different in patients with a foot joint arthrodesis in comparison to controls. METHODS The study was a comparative case series in a driving simulator under realistic driving conditions. Mobile patients without a walker, ≥6 months after surgery who were driving a car and had no neurological co-morbidity, knee or hip joint prosthesis were included in the study. The selection criteria resulted in 12 patients with right tibiotalar joint arthrodesis (TTJA) and 12 patients with another right foot joint arthrodesis (OFJA), who were compared to 17 individuals without any ankle-joint pathology. For TBRT, an empirical safe driving threshold of 700 ms was used. The outcome measures were RT, MT, TBRT, BF and McGuire score. RESULTS MT (p = 0.034) and TBRT (p = 0.026) were longer in TTJA patients in comparison with the controls. Also, more patients with TTJA than patients with OFJA and controls exceeded the safe driving threshold (p = 0.028). The outcomes in OFJA patients and in controls were comparable. The McGuire score was similar between the TTJA and OFJA patients (p = 0.26). CONCLUSIONS Significantly slower MT and TBRT, and significantly more patients exceeding the safe driving threshold, were observed after a tibiotalar-joint arthrodesis in comparison to the controls. Patients with OFJAs were not significantly different from the controls. Driving and emergency braking may be impaired after tibiotalar-joint arthrodesis.

Purpose: Numerous classification systems have been proposed to analyze lumbar spine MRI scans. When evaluating these systems, most studies draw their conclusions from measurements of experienced clinicians. The aim of this study was to evaluate the impact of specific measurement training on interobserver reliability in MRI classification of the lumbar spine. Methods: Various measurement and classification systems were assessed for their interobserver reliability in 30 MRIs from patients with chronic lumbar back and sciatic pain. Two observers were experienced spine surgeons. The third observer was an inexperienced medical student who, prior to the study measurements, in addition to being given the detailed written instructions also given to the surgeons, obtained a list of 20 reference measurements in MRI scans from other patients to practice with. Results: Excellent agreement was observed between the medical student and the spine surgeon who had also created the reference measurements. Between the two spine surgeons, agreement was markedly lower in all systems investigated (e.g., antero-posterior spinal canal diameter intraclass correlation coefficient [ICC] [3.1] = 0.979 vs. ICC [3.1] = 0.857). Conclusion: These data warrant the creation of publicly available standardised measurement examples of accepted classification systems to increase reliability of the interpretation of MR images.

OBJECTIVE To investigate if testing in a brake simulator can be replaced by a simple reaction timer setup imitating the ergonomic conditions of emergency braking when evaluating the ability to drive in patients with musculoskeletal problems of the lower extremities. METHODS A cross-sectional survey was performed in the Department of Orthopaedic Surgery in our University Hospital from October 2014 until May 2015. Patients attending our department with either osteoarthritis or arthroplasty of the knee or hip were asked to participate in the study if they had a valid driving license. The age limit was from 18 to 85 years. Both women and men were included. Registered demographic data were patient age, height, sex, body weight, and body mass index. Braking performance (brake response time [BRT]) was evaluated in a brake simulator that was embedded into a real car cabin (10 measurements). The values obtained were compared with those registered when simply testing (5 measurements) those patients with a normal reaction timer setup that imitated the sitting position in a car. Kendall's tau correlation coefficient was calculated between the values obtained from the brake simulator with those from the reaction timer setup. RESULTS Altogether, 137 patients (median age 67 years [range, 24-89 years]) with either osteoarthritis of the knee (n = 55) or hip (n = 82) were tested. Age was comparable in both collectives (P = 0.807). The mean body height was 1.70 m in both groups. Knee patients presented with a higher body weight of approximately 5 kg (P = 0.014) and consequently also had a higher body mass index (P = 0.023). The median BRT in the brake simulator was 628 ms (range, 390-1444 ms) for all subjects: 592 ms (range, 418-1146 ms) in the hip group and 696 ms (range, 390-1444 ms) in the knee group. Measurement values obtained by the reaction timer were significantly (P < 0.001) higher by approximately 15% (SD, 22%) than those measured in the brake simulator. A moderate correlation was found between the reaction timer and the brake simulator, with a Kendall's tau of 0.449 (P < 0.001) for all patients. Interestingly, hip patients showed a higher correlation (τ = 0.471) than knee patients (τ = 0.263). CONCLUSION Even though the measured correlations do not allow us to make a definite statement concerning braking performance, especially in knee patients, a simple reaction timer test can provide a low-cost first estimate of BRT for patients and their treating physicians. For forensic statements, the brake simulator will, however, remain the gold standard.

Background context Low back pain is commonly attributed to intervertebral disc (IVD) degeneration. IVD resembles articular cartilage in its biochemical and cellular composition in many ways. For articular cartilage, degeneration stage-specific characteristic spatial chondrocyte patterns have recently been described. Purpose This study addresses how spatial chondrocyte organization in the IVD changes from early embryonic development to end stage degeneration. Study design Ex vivo immunohistochemical analysis. Methods We immunohistochemically investigated bovine IVD-tissue (n=72) from early embryonic development to early disc degeneration and human adult IVD-tissue (n=25) operated for trauma or degeneration for cellular density and chondrocyte spatial organization. IVD samples were sectioned along the main collagen fiber orientation. Nuclei were stained with DAPI and their number and spatial patterns were analyzed in an area of 250,000 µm² for each tissue category. Results The initially very high cellular density in the early embryonic bovine disc (11,431 cells/mm²) steadily decreases during gestation, growth and maturation to about 71 cell/mm² in the fully grown cattle. Interestingly, in human degenerative discs, a new increase in this figure could be noted (184 cells/mm). The IVD chondrocytes appear to be predominantly present as single cells. Especially in the time after birth, string-formations represent up to 32% of all cells in the anulus fibrosus, although single cells are the predominant spatial pattern (>50%) over the entire time. With increasing degeneration, the relative proportion of single cells in human IVDs continuously decreases (12%). At the same time, the share of cells organized in clusters increases (70%). Conclusion Similar to articular cartilage, spatial chondrocyte organization appears to be a strong indicator for local tissue degeneration in the IVD. Clinical Significance In the future these findings may be important for the detection and therapy of IVD degeneration in early stages.

Targeted infiltrations to the lumbar spine are used to identify the correct scope for surgery in patients with chronic lumbar back pain (CLBP) and multi-segmental pathologies, where radiologic imaging and clinical presentation do not match. Conclusions from that method have so far been based on individual statements of pain relief. The main principle for the infiltrations is the assumption that by locally administering an analgesic agent to possible surgical target areas, the effect of surgery can be temporarily simulated. The aim was to investigate the use of rasterstereographic posture measurements to substantiate reported pain reduction after infiltrations.In this case-control study (Level II), rasterstereography was performed on 57 patients and 28 reference subjects to evaluate changes in posture during 1 week of injections under fluoroscopic guidance and correlated with changes in the Numeric Pain Rating Scale (NRS). Statistical analysis was performed with SPSS (The CLBP patients' trunk inclination (median 6°) and absolute lateral tilt were significantly increased (p .01 each) compared to the reference group. No significant difference was observed for trunk length, kyphotic/lordotic angle, or lateral deviation. During infiltration, no significant difference in posture could be observed. A subgroup analysis of patients reporting the highest pain improvement indicated no significant difference. No correlation was observed with pain improvement reported by the patients during injections. Subsequent rasterstereography does not seem to be able to verify results of injections in the diagnostics of lumbar spine pathologies, as patients' reported pain relief does not correlate with a relevant alteration in posture. The short-term effect of the targeted infiltrations may not suffice to change false posture being developed over years.Gezielte Infiltrationen der Lendenwirbelsäule im Rahmen einer Stufendiagnostik werden verwendet, um den Operationsumfang bei Patienten mit chronischen Rückenschmerzen (CLBP) und multisegmentalen Pathologien zu ermitteln, bei denen radiologische Bildgebung und klinische Darstellung nicht vollends übereinstimmen. Schlussfolgerungen aus dieser Methode basierten bisher auf individuellen Aussagen zur Schmerzlinderung. Das Hauptprinzip ist hierbei die Annahme, dass durch die lokale Verabreichung eines Analgetikums, an mögliche chirurgische Zielbereiche, der Effekt einer Operation vorübergehend simuliert werden kann. Studienziel war es, die rasterstereografische Haltungsmessungen zu untersuchen, um die patientenseitig angegebene Schmerzreduktion zu objektivieren.In dieser Fall-Kontroll-Studie wurde bei 57 Patienten und 28 Referenzpersonen eine Rasterstereografie durchgeführt, um Veränderungen der Körperhaltung während einer stationären Stufendiagnostik über den Zeitraum einer Woche zu bewerten und mit Veränderungen der numerischen Schmerzbewertungsskala (NRS) zu korrelieren. Die statistische Analyse wurde mit SPSS (α = 0,05, zweiseitig) durchgeführt und in Form von Box-, Scatter- und Bland-Altman-Diagrammen dargestellt.Die Rumpfneigung der CLBP-Patienten (Median 6°) und die absolute Seitenneigung waren im Vergleich zur Referenzgruppe signifikant erhöht (jeweils p 0,01). Für Rumpflänge, kyphotischen/lordotischen Winkel oder laterale Abweichung wurde kein signifikanter Unterschied beobachtet. Während der Infiltration konnten keine signifikanten Haltungsunterschiede festgestellt werden. Eine Subgruppenanalyse der Patienten mit der höchsten Schmerzverbesserung ergab keinen signifikanten Unterschied. Es wurde keine Korrelation mit der von den Patienten während der Injektionen berichteten Schmerzverbesserung beobachtet.Die Rasterstereographie scheint demnach nicht geeignet zu sein, die Ergebnisse im Rahmen der Stufendiagnostik zu objektivieren, da die berichtete Schmerzlinderung der Patienten nicht mit relevanten Änderungen der Körperhaltung korreliert. Der kurzfristige Effekt der gezielten Infiltration reicht möglicherweise nicht aus, um über Jahre hinweg entwickelte Fehlhaltungen zu ändern.

The rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician's work routine.This study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients' descriptions of alterations in their levels of pain.Back profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture.A significant reduction in kyphotic (52-43°, p = 0.014) and lordotic (28-11°, p 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98-91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence.Although both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.

Background Spinal surgeries have strongly increased in number over the past decade. The question of when it is safe to resume driving is thereby one the most frequently asked questions that patients ask of their treating physician. Objective The aim of this study was to assess braking performance before and after spine surgery. Methods Reaction time, foot transfer time (together brake response time [BRT]), and brake force (BF) were evaluated in a drive simulator. A longitudinal patient cohort (n= 27) was tested preoperatively and at the first follow-up. A cross-sectional cohort (n= 27) was tested at > 1 year postoperatively. The values from these groups were compared with a healthy age-matched control group of 24 volunteers. Results No significant improvement in BRT was seen in lumbar fusion three months postoperatively (p= 0.597); BF was even weaker than it was preoperatively (p= 0.044). In comparison to the control group (median BRT 479 ms), preoperative BRT was already impaired in lumbar fusion patients (median 560 ms), representing an increased braking distance of 2.25 m at 100 km/h. Conclusion Although most patients performed adequately, about one third presented critical braking performance. Risk factors for impaired braking may include scheduled multisegmental fusion surgery, female sex, and pain.

The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.

Zusammenfassung Hintergrund Die Indikationsstellung zur Operation bezieht ihre Legitimation zum Eingriff in die körperliche Unversehrtheit eines Patienten im Wesentlichen aus dem zu erwartenden Behandlungserfolg. Um die Wahrscheinlichkeit und das Ausmaß eines Operationserfolgs bereits präoperativ abzuschätzen, muss der Chirurg in kurzer Zeit eine Fülle an Parametern evaluieren, die über die rein technische Dimension des Eingriffs hinausgehen. Trotz höchster Versorgungsstandards zeigt die postoperative patientenseitige Zufriedenheit eine immense Streubreite bei für den Arzt technisch zufriedenstellendem Ergebnis. Ziel der folgenden Studie war es, zu untersuchen, mit welcher Präzision individuelle postoperative Zufriedenheit und Schmerzangabe von Patienten bei elektiven muskuloskeletalen Eingriffen vorhergesagt werden können, und ob diese Vorhersagepräzision abhängig ist vom ärztlichen Ausbildungsstand. Zudem sollte evaluiert werden, ob bei einem hoch standardisierten Eingriff, wie dem endoprothetischen Gelenkersatz, eine höhere Präzision möglich ist als im restlichen Operationsgut. Material und Methoden Die Ärzte der Klinik gaben präoperativ eine Einschätzung über die erwartete Zufriedenheit (Skala 0 – 10) und Schmerzstärke (NRS) der Patienten für den Zeitpunkt 6 Monate postoperativ ab. Zu diesem Zeitpunkt erfolgte dann die Erhebung dieser Parameter bei den Patienten. Die ärztliche Beurteilung erfolgte im Rahmen der präoperativen Visite am Vortag zur Operation. Unterschiedlich erfahrene Kollegen konnten so zeitgleich dieselben Patienten einschätzen. Verglichen wurden die Angaben von Ober- und Fachärzten mit denen der Assistenzärzte in Gegenüberstellung zu den Angaben der Patienten. Ergebnisse Insgesamt wurden 194 Einschätzungen ausgewertet. Durch die Operation konnte eine deutliche Schmerzbesserung erzielt werden (Median NRS prä-OP 6,25, post-OP 2,5, p Schlussfolgerung Auch wenn sich die ärztliche Einschätzung insgesamt mit den Patientenangaben annähernd deckt, so sind auf den Einzelfall bezogen starke Abweichungen zu verzeichnen, die auch in einem hoch standardisierten Kollektiv, wie dem der primären Endoprothetik, bestehen. Eine Zunahme der Einschätzungsqualität mit fortschreitendem ärztlichem Ausbildungsstand war nicht festzustellen. Hier lassen die Daten die Vermutung zu, dass über die technische Dimension hinaus andere Faktoren ebenfalls von entscheidender Bedeutung sind, wie z. B. die präoperative Erwartungshaltung des Patienten. Anspruch eines jeden Operateurs muss es daher sein, eine realistische Erwartung an die Operation mit dem Patienten gemeinsam zu entwickeln und sich dabei der eigenen Grenzen bez. der Vorhersagepräzision des Erfolgs bewusst zu sein.

Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p

Patients with chronic lumbar back pain (CLBP) often present with an altered gait profile, which is a crucial element of good functioning in everyday life. In patients with multisegmental spinal pathologies and incongruity between radiologic imaging and clinical presentation, inpatient gradual diagnostics (IGD) is performed to determine the precise origin of the disabling pain. The underlying principle of IGD is the assumption that by locally administering an analgesic and anti-inflammatory agent to possible surgical target areas, the surgical effect can be temporarily simulated. The conclusions drawn from IGD are, however, mostly based on the patients' subjective feedback about pain relief.The aim of this study was to evaluate whether reported pain relief during IGD can be objectified by gait analysis. We hypothesized that patients with greater pain relief during IGD would show greater improvement in their pathologic gait and stance.Treadmill gait and stance analyses were prospectively performed on CLBP patients before and after a one-week IGD. Self-report measures included the numeric pain rating scale (NRS) and the Oswestry Disability Index (ODI).Compared with a reference group (n = 28), IGD patients (n = 57) at admission showed reduced velocity, cadence, step length, and swing phase (p .01 each). Their stance phase was increased by 5% of the gait cycle, and a more asymmetrical total load distribution during stance was observed. No difference was seen in stride width or foot rotation. While many patients reported good pain relief during IGD, no correlation was observed between subjective improvement and treadmill measures. We can thus confirm a pathologic gait profile in patients with CLBP. Based on our findings, gait analysis would not yet seem suitable to objectify IGD results. The short time interval between admission and discharge may not suffice to change a pathological gait that has developed over years.

Objective The objective of this study was to investigate whether total knee arthroplasty (TKA) impairs the ability to perform an emergency stop. Design An automatic transmission brake simulator was developed to evaluate total brake response time. A prospective repeated-measures design was used. Forty patients (20 left/20 right) were measured 8 days and 6, 12, and 52 wks after surgery. Results Eight days postoperative total brake response time increased significantly by 30% in right TKA and insignificantly by 2% in left TKA. Brake force significantly decreased by 35% in right TKA and by 25% in left TKA during this period. Baseline values were reached at week 12 in right TKA; the impairment of outcome measures, however, was no longer significant at week 6 compared with preoperative values. Total brake response time and brake force in left TKA fell below baseline values at weeks 6 and 12. Brake force in left TKA was the only outcome measure significantly impaired 8 days postoperatively. Conclusion This study highlights that categorical statements cannot be provided. This study's findings on automatic transmission driving suggest that right TKA patients may resume driving 6 wks postoperatively. Fitness to drive in left TKA is not fully recovered 8 days postoperatively. If testing is not available, patients should refrain from driving until they return from rehabilitation.

The question of whether patients with musculoskeletal disorders are fit to drive is of paramount importance for them and frequently is directed to the treating orthopedic specialist. Although perioperative braking performance has been increasingly investigated in recent years, scientific data on braking safety in individuals with osteoarthritis (OA) are scarce. This study analyzed the braking performance of 158 patients with OA of the right or left knee or hip and compared the results with radiographic OA grading according to the Kellgren-Lawrence classification scale. Reaction time and foot transfer time (together called brake response time [BRT]) and brake force were measured in a real car cabin, and the values were compared with measurements obtained from young (n=34) and age-matched (n=36) control groups. Although the majority of BRTs in both control groups remained below 600 milliseconds, patients with both hip and knee OA, whether on the right or left side, had significantly worse values ( P P =.92; Kendall tau for brake force: τ=−0.014, P =.82), which makes radiographs an inadequate tool for medical driving recommendations. [ Orthopedics. 2017; 40(1):e82–e89.]

BACKGROUND Fitness to drive a car has been investigated increasingly over recent years. However, most research has focussed on perioperative driving performance, and few data are available on how orthoses influence the ability to perform an emergency stop. This study investigated the effect of 4 common ankle braces (Kallassy, CaligaLoc, Air-Stirrup, ASO) on reaction time, foot transfer time (together: brake response time) and brake force. The hypothesis was that wearing these braces on the right ankle impairs braking performance, specifically by increasing foot transfer time, but also by altering brake force. METHODS A car cabin was set up with measurement equipment to register reaction time, foot transfer time, brake response time and brake force under realistic spatial constraints. A crossover repeated measures design was used to test 30 healthy volunteers with and without each of the braces. RESULTS All 4 braces resulted in statistically significantly increased foot transfer time (p

Background Although a person's fitness to drive has gained more attention over the past few years, investigations have focused mainly on postsurgical (eg, hip arthroplasty) driving performance. Few data are available on how orthoses affect the ability to perform an emergency stop. Objective To determine whether common lumbar and hip orthoses impair driving performance by increasing brake response time and weakening brake force (BF). Design Crossover repeated measures design. Setting University hospital. Participants A crossover, repeated-measures design was used to test 30 healthy volunteers with and without each of the orthoses in random order. Methods A custom-made simulator was created from a car cabin fitted with measurement equipment to record braking parameters under realistic spatial constraints. Main Outcome Measurements Reaction time (RT), foot transfer time (FTT) (these 2 together: brake response time), and maximum BF. Results Although spine orthoses lead to statistically significant increases in RT (Vertebradyn-Strong, P = .002; Horizon 637 LSO, P = .32; and SofTec Dorso, P = .013), this effect was not observed in hip orthoses, where instead FTT was prolonged (DynaCox and Hohmann-like orthosis, P Conclusions This study demonstrates that hip and spine orthoses lead to impaired driving performance. Depending on the type of immobilization, this effect mostly increases RT or FTT, lengthening total stopping distances by up to half a meter at 100 km/h. However, in the absence of an underlying pathological condition in individuals with orthoses, their braking performance should be sufficient to continue driving.

To show the possible effect of left- and right-side total hip arthroplasty (THA) on the ability to perform an emergency stop when driving a car.Inception cohort.A driving simulator using an actual car cabin, specifically developed for the experiment, was used for testing driving ability.Patients (N=40; 20 left-side THA/20 right-side THA) were tested preoperatively and in increments of 8 days and 6, 12, and 52 weeks after surgery.Left- and right-side THA.Reaction time, movement time, total brake response time (TBRT), and maximum brake force.Eight days postoperatively, measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA. For both patient groups, significant improvements in outcome measures were noted during the 1-year follow-up. Brake force declined significantly in patients with left-side THA (P=.012) and in patients after right-side THA (P.001). A total of 35% of the patients with right-side THA and 15% with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively.Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery. Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively. Because of the patients' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle, individual examination and recommendation are necessary.